Global Burden of Cardiovascular Diseases

In recent years, the dominance of chronic diseases as major contributors to total global mortality has emerged and has been previously described in detail elsewhere. By 2005, the total number of cardiovascular disease (CVD) deaths (mainly coronary heart disease, stroke, and rheumatic heart disease) had increased globally to 17.5 million from 14.4 million in 1990. Of these, 7.6 million were attributed to coronary heart disease and 5.7 million to stroke. More than 80 percent of the deaths occurred in low and middle income countries (WHO, 2009e).

Based on 2007 to 2010 data, 33% of US adults ≥ 20 years of age have hypertension. This represents ~ 78 million US adults with hypertension. The prevalence of hypertension is similar for men and women. African American adults have among the highest prevalence of hypertension (44%) in the world.

Angina Pectoris: Differential Diagnosis

Sep 20, 2005 Viewed: 890

Differential Diagnosis
Angina can usually be diagnosed from a proper history. When atypical features are present - such as prolonged duration (hours or days) or darting, knifelike pains at the apex or over the precordium - ischemia is less likely.

Anterior chest wall syndrome is characterized by sharply localized tenderness of intercostal muscles. Inflammation of the chondrocostal junctions, which may be warm, swollen, and red, may result in diffuse chest pain that is also reproduced by local pressure (Tietze’s syndrome). Intercostal neuritis (due to herpes zoster, diabetes mellitus, etc) also mimics angina.

Cervical or thoracic spine disease involving the dorsal roots produces sudden sharp, severe chest pain suggesting angina in location and “radiation” but related to specific movements of the neck or spine, recumbency, and straining or lifting.

Pain due to cervical or thoracic disk disease involves the outer or dorsal aspect of the arm and the thumb and index fingers rather than the ring and little fingers.

Peptic ulcer, chronic cholecystitis, esophageal spasm, and functional gastrointestinal disease may produce pain suggestive of angina pectoris. Reflux esophagitis is characterized by lower chest and upper abdominal pain after heavy meals, occurring in recumbency or upon bending over. The pain is relieved by antacids, sucralfate, H2 receptor antagonists, or proton pump inhibitors. The picture may be especially confusing because ischemic pain may also be associated with upper gastrointestinal symptoms, and esophageal motility disorders may be improved by nitrates and calcium channel blockers. Assessment of esophageal motility may be necessary.

Degenerative and inflammatory lesions of the left shoulder and thoracic outlet syndromes may cause chest pain due to nerve irritation or muscular compression; the symptoms are usually precipitated by movement of the arm and shoulder and are associated with paresthesias.

Spontaneous pneumothorax may cause chest pain as well as dyspnea and may create confusion with angina as well as myocardial infarction. Even the ECG may resemble infarction because of changes in voltage from the pneumothorax. The same is true of pneumonia and pulmonary embolization. Dissection of the thoracic aorta can cause severe chest pain that is commonly felt in the back; it is sudden in onset, reaches maximum intensity immediately, and may be associated with changes in pulses. Other cardiac disorders such as mitral valve prolapse, hypertrophic cardiomyopathy, myocarditis, pericarditis, aortic valve disease, or right ventricular hypertrophy may cause atypical chest pain or even myocardial ischemia. Noninvasive testing and, in many cases, cardiac catheterization may be required to establish the diagnosis.

It's easy to make a financial decision based on what you need right now, but making an informed choice will benefit you in the long run. Meet a former Red Sox pitcher who picked security over an uncertain future